Varieties of Qualifications, Training, and Skills in Long‐Term Care: A German, Japanese, and UK Comparison

• Author: Howard Gospel
• DOI: http://doi.org/10.1002/hrm.21714
• Published date: 01 September 2015
• Date: 01 September 2015

Human Resource Management, September–October 2015, Vol. 54, No. 5, Pp. 833–850

© 2015 Wiley Periodicals, Inc.

Published online in Wiley Online Library (wileyonlinelibrary.com).

DOI:10.1002/hrm.21714

Correspondence to: Howard Gospel, Management Department, King’s College London, Stamford Street, London,

England SE1 9NH, Phone: +44 1865 516700, E-mail: h.gospel@kcl.ac.uk and howard.gospel@sbs.ox.ac.uk

VARIETIES OF QUALIFICATIONS,

TRAINING, AND SKILLS

IN LONG-TERM CARE: A GERMAN,

JAPANESE, AND UK COMPARISON

HOWARD GOSPEL

This article considers the systems of qualifi cations and training in the long-term

elderly care sector in Germany, Japan, and the United Kingdom. Each country

faces similar challenges of coping with increasing demand and securing staff

for quality and cost-effective care. However, the three countries organize quali-

fi cations and training in very different ways. In the case of formal care work-

ers, there is a hierarchy of training and skills, with Germany at the top, Japan

in the middle, and the United Kingdom at the bottom. However, comparing the

whole workforce, Germany has developed a dualistic structure with both highly

and lowly trained workers; Japan has developed a relatively large proportion

of moderately trained and qualifi ed staff; and the UK workforce consists of a

relatively large proportion of lowly trained and unqualifi ed workers. Explana-

tions are considered and implications offered for human resource management.

©2015Wiley Periodicals, Inc.

Keywords: training and development, health care, international management

Long-term care (LTC) for the elderly has been

one of the most rapidly expanding sectors

in advanced economies. This reflects demo-

graphic changes, with growing popula-

tions of older people. It also reflects social

developments, with less provision of care within

the extended family. In parallel, over the past

two decades, there has been a massive growth of

the care workforce that is predicted to continue

well into the future (Organization for Economic

Cooperation and Development [OECD], 2011a).

There are two major issues—the need for

quality care and cost-effective care. These issues

concern all parties: older people and their fami-

lies, governments and society, employers, and

employees. Given this, governments have pursued

various strategies. Thus, insurance-based systems

have been introduced in some countries, includ-

ing Germany and Japan. In most countries, care

management systems have developed to evaluate

needs and coordinate services. In many countries,

quasi-market mechanisms have been introduced,

including more private providers. In addition,

there has been the introduction of inspection

systems to regulate care provision (OECD, 2005,

2011a).

Attention has also been paid by governments

and employers to the training and management

of the workforce (Fujisawa & Colombo, 2009;

OECD, 2013). This reflects both the expansion

of the sector and the traditional underdevelop-

ment of formal qualifications and training. It also

834 HUMAN RESOURCE MANAGEMENT, SEPTEMBER–OCTOBER 2015

Human Resource Management DOI: 10.1002/hrm

3. To what extent have qualifications and train-

ing in this sector built on prevailing national

systems, and to what extent have they been

created anew?

4. How have national systems of qualifications

and training fed through to HRM practices at

the organizational level?

Framing the Discussion

In framing the article, we consider these four ques-

tions, as stimulated by the relevant literatures. The

first three are the primary focus of the article. In

answer to these questions, findings are presented.

The final question considers implications, but this

requires further research and space to develop. In

answer to this latter question, broad implications

are presented.

First, what are the different types of qualifica-

tions and training in the three countries? Related

to this question are the differing levels at which

qualifications are set and the proportions obtain-

ing the various qualifications. This is very much

a practical and policy question for governments,

employers, and employees. It is also an academic

question that relates to literature on different

types of qualification and training and to their

interaction with skills (Brockmann, Clark, &

Winch, 2011; Imano & Shimoda, 1995).

Second, are there any tendencies to conver-

gence in qualifications, training, and skills across

the three countries? On the one hand, this might

be expected because of commonalities in the

nature of the work and in quality and cost pres-

sures in the three countries. On the other hand,

although in some ways this is a “new” sector, path

dependencies in terms of national institutions

might be expected to make for continuing diver-

sity. Again, this is a policy question since it relates

to the ability of countries to change arrangements

and to borrow from one another. It also relates to

the academic literature on complementarities in

national systems, change mechanisms, and obsta-

cles to change (Crouch, 2010; Thelen, 2004).

Third, to what extent have qualifications and

training in this sector built on prevailing national

systems or been created anew? This question relates

to the determinants of qualifications and training

systems. Here, we ask whether there are any driv-

ers associated with the different varieties of welfare

states (VoWS) or the different varieties of capital-

ism (VoC) represented by the three countries. This

is very much a theoretical question, relating to two

bodies of literature—welfare state regimes (with

origins in Esping-Andersen, 1990) and national

business systems (associated with authors such as

Hall & Soskice, 2001, and Whitley, 1999).

reflects the nature of the work, which is becoming

more complex, as the needs and expectations of

older people increase. Up-skilling the workforce is

seen as a way of improving both quality and effi-

ciency. For service providers, training is necessary

to meet the increasing demands from users. For

employees, training helps them to perform diffi-

cult tasks better and potentially increases career

opportunities. However, for employers, labor costs

are a high proportion of total costs and need to

be contained. In turn, this potentially impedes

training, as does the growth of precarious forms of

employment (Fujisawa & Colombo, 2009; OECD,

2011a).

In this article, three countries (Germany, Japan,

and the United Kingdom) were chosen as large

advanced economies, with similarities in terms

of the growing demand for LTC, increasing qual-

ity and cost pressures, and a continuing search for

new policies and practices. The countries are also

often seen as archetypes of national varieties of

labor market training—Germany with apprentice-

based occupational labor markets (OLMs), Japan

with firm-based internal labor markets (ILMs),

and the United Kingdom with more external labor

markets (ELMs). (These types will be developed in

the next section). A key question is to what extent

are such national archetypes followed in the train-

ing and qualifications of care staff.

In terms of data, the three countries have

extensive literatures (governmental, practitio-

ner, and academic), including comparative data

collected by the OECD and other international

agencies. However, the literature that focuses

on training and skills in comparative perspec-

tive is more limited (Fujisawa & Colombo, 2009;

Simonazzi, 2009). For its empirical base, the article

draws on material in the form of the most author-

itative government reports, statistical materials

from official and sectoral agencies, and material

from industry bodies. It also draws on a series of

interviews carried out in each country with gov-

ernmental organizations, employer bodies, trade

unions, and care providers.1 The article seeks to

synthesize these data.

The article considers four main research ques-

tions that relate to varieties of systems, deter-

minants, trends, and implications for human

resource management (HRM):

1. What are the different types of qualifications

and training in the three countries, at what

level are they set, and how many obtain

them?

2. Are there any tendencies to convergence in

qualifications, training, and skills across the

three countries?